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This Article Full Text Full Text (PDF) All Versions of this Article: ERC-09-0042v1 16/3/885    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Ahmed, A Articles by Ramage, J K PubMed PubMed Citation Articles by Ahmed, A Articles by Ramage, J K

¹ Basingstoke and North Hampshire Foundation Trust, Basingstoke, UK
² Institute of Liver Studies and Department of Nuclear Medicine, Kings College Hospital, London, UK
³ Neuroendocrine Tumour Unit, Royal Free Hospital, London, UK
⁴ Department of Surgery, University Hospital Aintree, Liverpool, UK
⁵ Neuroendocrine Tumour Group, Royal Victoria Hospital, Belfast, UK
⁶ Research and Development Support Unit, University of Southampton, Southampton, UK

(Correspondence should be addressed to J K Ramage, Department of Gastroenterology, Basingstoke and North Hampshire Foundation Trust, Aldermaston Road, Basingstoke, Hampshire RG24 9NA, UK; Email: john.ramage{at}bnhft.nhs.uk)

We intended to identify the prognostic factors and the results of interventions on patients with liver metastatic midgut carcinoids. Five institutions that are part of United Kingdom and Ireland neuroendocrine tumour (NET) group took part in this study. Patients were included if they had histology proven NET of midgut origin and liver metastases at the time of the study. Clinical and biochemical data were collected retrospectively from hospital charts, pathology reports, radiology reports and biochemistry records for each patient. Three hundred and sixty patients were included in the study. The median survival from date of diagnosis was 7.69 years (confidence interval (CI) 6.40–8.99) and 5.95 years (CI 5.02–6.88) from date of diagnosis of liver metastases. On univariate analysis, increasing age at diagnosis, increasing urinary hydroxyindole acetic acid levels, increasing plasma chromogranin A levels, high Ki67, high tumour volume and treatment with chemotherapy were identified as factors associated with a significantly poorer outcome. Resection of liver metastases, resection of small bowel primary, treatment with somatostatin analogue therapy and treatment with peptide receptor therapy were associated with improved prognosis. Multivariate analysis revealed that age at diagnosis (P=0.014), Ki67 level (P=0.039) and resection of primary (P=0.015) were independent predictors of survival. This is the largest study to our knowledge looking specifically at the prognosis and clinical course of patients with liver metastatic midgut NETs. For the first time, we have shown that Ki67 and resection of primary are independent predictors of survival for this group of patients.